Provider Demographics
NPI:1538576095
Name:CRICKMAN, CHARLES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:CRICKMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 EDISTO AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2352
Mailing Address - Country:US
Mailing Address - Phone:843-861-5452
Mailing Address - Fax:
Practice Address - Street 1:204 W PINE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4725
Practice Address - Country:US
Practice Address - Phone:843-629-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist